Infusion pump with tube loading guidance and confirmation

ABSTRACT

An infusion pump includes a housing with a door pivotally mounted to the housing, a tube channel on the housing configured to hold a tube in the infusion pump, a pumping mechanism including a shuttle, and a slide clamp ejection device.

RELATED APPLICATIONS

This application is a divisional application based on U.S. applicationSer. No. 16/413,037, filed on May 15, 2019, entitled “INFUSION PUMP WITHTUBE LOADING GUIDANCE AND CONFIRMATION” which claims the benefit of andpriority to U.S. Provisional Patent Application No. 62/671,858 filed May15, 2018, entitled “INFUSION PUMP,” which is incorporated herein byreference in its entirety.

BACKGROUND

Previous medical infusion pumps have comprehended a wide variety ofmethods for pumping fluids into a patient. The most common of thesemethods has been a peristaltic pump. In a peristaltic pump, a pluralityof actuators or fingers serve to massage a parenteral fluid deliverytube in a substantially linear progression. The primary problemassociated with peristaltic pumping technology is that the tube isrepeatedly deformed in an identical manner, thereby over the course oftime destroying the elastic recovery properties of the tube so that thetube maintains a compressed aspect. This destruction of the elasticrecovery properties of the tube results in the volumetric output of thepump changing markedly over time. Another common type of pump used inthe volumetric delivery of medical fluids is commonly known as acassette pump. Although cassette pumps do not display the fairly rapiddegradation of performance as evidenced in a peristaltic pump, theyrequire a fairly elaborate pump cassette to be integrated with the IVtube. This added expense of having to change a cassette along with an IVset every time an operator wishes to change the medicament delivered tothe patient, significantly raises the cost of patient care.Additionally, as both peristaltic and cassette pumps, as well as otherinfusion devices present in the market, require a fairly elaborateknowledge of the specific pumping device to ensure that the IV set isloaded appropriately, generally medical infusion pumps were purely thepurview of the nursing or medical staff in a hospital environment.

The necessity of manually loading a set into an IV pump is universal inthe art. Generally, when a standard IV set is used, in addition to therapid degradation of accuracy mentioned above, difficulty is encounteredin correctly loading the set into those pumps presently in the art. Thestate of the art of loading technology as it relates to medical infusionpumps has progressed only to the state of enclosing the IV tube betweena pumping device and a door or cover and adding progressively moreelaborate sensors and alarms to assure that the tube is correctly loadedinto the pump. Even so, loading errors may occur requiring great effortson the part of hospital staffs to ensure that critical errors areminimized.

The state of the art in infusion pumps also includes the requirement ofmanually assuring that a free-flow condition of medicament does notoccur when an IV set is installed or removed from a pump. Althoughhospital staffs exercise great care and diligence in their attempts toassure that free-flow conditions do not occur, a demonstrable need foradditional precautions directed to the prevention of a free-flowcondition has been a continuous concern of healthcare workers.

SUMMARY

The instant invention provides for an infusion pump wherein the pump hasa pumping body, which consists of a v-shaped groove extendinglongitudinally along a pump assembly and has associated therewith afixed, and a moveable jaw and a plurality of valves located at eitherend of the v-shaped groove or shuttle.

In operation, an operator such as a nurse or patient would commenceinfusion of a medicament by inserting a standard IV set tube into atube-loading orifice located on the front of the pump. Additionally, theoperator would simultaneously insert a slide clamp, which is associatedwith the tube into an appropriate slide clamp orifice located upstream,i.e. more toward the fluid source, of the tube-loading orifice. Theoperator would then actuate a tube loading sequence to load the tubeinto a tubeway. In an example, a series of pawls and a moveable upperjaw would serve to seize the tube and draw it into a tubeway, part ofwhich is comprised of the v-shaped groove and valves. As the loadingcycle progresses, the jaws and pawls close about the tube capturing thetube within the tubeway. Sequentially as the valves close to occlude thetube, the slide clamp would be moved to a position such that the slideclamp would no longer occlude the tube. Upon receipt of appropriatesignals from associated electronics which would determine the pumpingspeed, allowable volume of air, temperature and pressure, the pump isactuated wherein fluid is drawn from the fluid source and expelled fromthe pump in a constant and metered amount.

Should the tube be misloaded into the tubeway or the tube-loadingorifice, appropriate sensors would determine the existence of such astate and effect an alarm directed thereto. At the end of the infusion,actuation by an operator would serve to automatically close the slideclamp and release the tube from the pump.

The pump comprehends a variety of sensors directed to improve the safetyof the infusion of medicament and which provide information on the stateof the fluid passing through the pump. For example, the sensors provideinformation regarding the state of various mechanical subassemblieswithin the pump itself such as a positional location of the shuttle orv-shaped slot aforementioned, valve operation, slide clamp location, andmisload detection.

The sensors relating to the state of the fluid being passed through thepump have themselves been improved with regard to accuracy. This hasbeen accomplished by the development of a method of making contactbetween the sensor and the tube such that the contact is normal to thetube and the tube is placed in contact with the various sensors in sucha way that there is neither a volumetric nor a stress gradient acrossthe tube.

Aspects of the subject matter described herein may be useful alone or incombination with one or more other aspects described herein. In anexemplary aspect of the present disclosure, an infusion pump includes ahousing with a door pivotally mounted to the housing.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump includes a tube channel on the housingconfigured to hold a tube in the infusion pump. The tube channel may bepositioned at least partially behind the door.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump includes a pumping mechanism including ashuttle. The pumping mechanism may be positioned behind the door.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump includes a slide clamp ejection deviceconfigured to eject a slide clamp from a channel.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the slide clamp ejection device includes a solenoid configuredto automatically eject the slide clamp based on one or more inputs fromone or more sensors arranged on the infusion pump.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the one or more sensors include a first Hall effect sensorconfigured to detect when the door is positioned in the closed state.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the one or more sensors include an IR sensor configured todetect when the door is latched while positioned in the closed state.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the one or more sensors include a pressure sensor configured todetect the presence of the tube at a load point along the tube channel.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the one or more sensors include a second Hall effect sensorconfigured to detect that a valve is closed to place the tube in anoccluded state.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump is configured to initiate an infusion afterreceiving a confirmation that at least one of the slide clamp is in anejected state and the door is in a closed state.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the tube is in an occluded state after the slide clamp isinserted within the channel.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump includes a sensor that detects the presenceof the slide clamp within the channel.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump further includes a tube loading guidancesystem, wherein the tube loading guidance system includes one or morevisual cues configured to provide guidance to a user during tubeloading.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the visual cues include a first light-emitting diode, a secondlight emitting diode, and a display. The first and second light emittingdiodes are configured to indicate whether a tube is properly orimproperly loaded at respective load points on the infusion pump.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump further includes an occlusion sensor. Theocclusion sensor is configured to determine if an infusion lineconnected to the infusion pump is blocked.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the occlusion sensor determines if an infusion line is blockedby calculating a slope of a force curve, a slope of a pressure curve, acomparison to a baseline force measurement, a comparison to a baselinepressure measurement, or an area under the force curve.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump further includes an accelerometer. Theaccelerometer is configured to detect an occlusion and/or whether theinfusion pump experienced an external impact.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the infusion pump is positioned in a rack with at least oneother infusion pump or syringe pump.

Aspects of the subject matter described herein may be useful alone or incombination with one or more other aspects described herein. In anotherexemplary aspect of the present disclosure, a tube loading guidancesystem for positioning a tube within an infusion pump housing includes afirst visual cue, a second visual cue, and a third visual cue. The firstvisual cue is configured to indicate both proper and improper loading ofa slide clamp in the infusion pump. The second visual cue is configuredto indicate both proper and improper loading of the tube at a first loadpoint in the infusion pump. Additionally, the third visual cue isconfigured to indicate both proper and improper loading of the tube at asecond load point in the infusion pump.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the second visual cue and the third visual cue include lightemitting diodes.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the light emitting diodes indicate proper loading byilluminating in a first color. Additionally, the light emitting diodesindicate improper loading by illuminating in a second color.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the second visual cue is illuminated based on an output from apressure sensor associated with the first load point.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the third visual cue is illuminated based on an output from adifferent pressure sensor associated with the second load point.

Aspects of the subject matter described herein may be useful alone or incombination with one or more other aspects described herein. In anotherexemplary aspect of the present disclosure, a method of detecting anocclusion includes monitoring a pressure measurement, comparing thepressure measurement to a threshold, and determining an occlusion existswithin a tube of an infusion pump when the pressure measurement isgreater than the threshold. The pressure measurement may be based on acurrent ADC, a baseline ADC, and a slope of an ADC-pressure plot.Additionally, the threshold may be based on a selected occlusiondetection mode.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the selected occlusion detection mode includes one of a rapidocclusion detection mode and a non-rapid occlusion detection mode.

In accordance with another exemplary aspect of the present disclosure,which may be used in combination with any one or more of the precedingaspects, the threshold is lower for the rapid occlusion detection modethan the non-rapid occlusion detection mode.

To the extent that any of these aspects are mutually exclusive, itshould be understood that such mutual exclusivity shall not limit in anyway the combination of such aspects with any other aspect whether or notsuch aspect is explicitly recited. Any of these aspects may be claimed,without limitation, as a system, method, apparatus, device, medium, etc.

Therefore, it is a primary object of the invention to provide for aninfusion pump capable of delivering an accurate volume of medicamentusing a standard infusion set.

It is another object of the invention to provide an infusion pumpcapable of detecting proper IV tube loading.

It is another object of the invention to provide an infusion pumpcapable of providing IV tube loading guidance to a user.

It is a further object of the invention to provide automaticallyactuated slide clamp ejection based on various pump sensor input.

It is another object of the invention to provide occlusion detection foran infusion pump.

It is an additional object of the invention to provide drop detectionfor an infusion pump.

It is a further object of the invention to provide power management foran infusion pump loaded in a rack configuration.

Additional features and advantages of the disclosed infusion pump aredescribed in, and will be apparent from, the following DetailedDescription and the Figures. The features and advantages describedherein are not all-inclusive and, in particular, many additionalfeatures and advantages will be apparent to one of ordinary skill in theart in view of the figures and description. Also, any particularembodiment does not have to have all of the advantages listed herein.Moreover, it should be noted that the language used in the specificationhas been principally selected for readability and instructionalpurposes, and not to limit the scope of the inventive subject matter.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A and 1B are perspective views of an infusion pump with the doorclosed according to an example embodiment of the present disclosure.

FIGS. 1C and 1D are perspective views of an infusion pump with the dooropen according to an example embodiment of the present disclosure.

FIG. 2 illustrates a block diagram of an example infusion pump systemaccording to an example embodiment of the present disclosure.

FIGS. 3A, 3B, 3C and 3D are isometric views of a solenoid actuated slideclamp ejection mechanism according to an example embodiment of thepresent disclosure.

FIGS. 4A, 4B and 4C are alternative embodiments of automated slide clampejection mechanisms.

FIG. 5 is a flow chart of an example process for tube loading guidanceaccording to an example embodiment of the present disclosure.

FIG. 6 is a flow chart of an example process for tube loading guidanceaccording to an example embodiment of the present disclosure.

FIG. 7 is an example flow chart for detecting a disturbance of a pumpusing an accelerometer according to an example embodiment of the presentdisclosure.

FIGS. 8A and 8B are partial views of an infusion pump with tube loadingvisual indicators, according to an example embodiment of the presentinvention.

FIGS. 9A, 9B and 9C are partial views of an infusion pump with tubeloading visual indicators, according to an example embodiment of thepresent invention.

FIG. 10 is an isometric view of an infusion pump with visual indicatorsaccording to an example embodiment of the present invention.

DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS

The below disclosure relates to an infusion pump 100. Infusion pump 100may employ a pump assembly and other features such as and not limited tothose described in U.S. Pat. No. 6,213,738; a volumetric infusion pumpwith automatic tube load described in U.S. Pat. No. 6,123,524; avolumetric infusion pump described in U.S. Pat. No. 6,013,057; avolumetric infusion pump described in U.S. Pat. No. 6,129,517; avolumetric infusion pump described in U.S. Pat. No. 6,195,887; avolumetric infusion pump described in U.S. Pat. No. 6,213,723; and aperistaltic pump described in GB Application No. 2238083A, the entiretyof which are incorporated herein by reference. The above examples arenon-limiting and the concepts disclosed herein could apply to othermedical devices and/or infusion pumps such as a syringe pump.

Referring to FIGS. 1A, 1B, 1C and 1D, an infusion delivery system, suchas an infusion pump 100 is used to deliver fluids (e.g., medications ornutrients) to a patient in predetermined quantities. The infusion pump100 includes a housing 110, a door 120 pivotally connected to thehousing 110, a display 130, and a keypad 140. The display 130 and keypad140 are located on the door 120 along with beacon 150. The display 130and the keypad 140 are used to program the infusion pump 100, and morespecifically, a processor in the pump to set the fluid delivery amount,etc., which is later communicated to the pumping mechanism. It should beappreciated that in various other embodiments, one or more elements ofthe display 130 and the keypad 140 could be combined in central touchscreen.

Beacon 150 may be used as an indicator beacon that emits light or soundto indicate operational states or status of pump 100. For example, whenthe pump 100 is operating normally and infusing fluids, the beacon 150may emit a solid green light. During a medium priority alarm, the beacon150 may emit a flashing yellow light. Similarly, during a high priorityalarm, the beacon may emit a flashing red light. The beacon 150 may emitother combinations of colors at various intervals (e.g., pulsing,blinking, solid light) or other audible alerts to indicate theoperational state or status of pump 100.

When the pump 100 is in use, fluids may move through a tube loaded intothe pump 100. The tube 160 is loaded along the tube channel 162 on thepump 100. Along the tube channel 162, the tube passes through a slideclamp 115, an ultrasonic air sensor 172, an upstream pressure sensor 174a, an upstream valve 176 a, the shuttle pumping region 180, a downstreamvalve 176 b, and a downstream pressure sensor 174 b. Positioned on thedoor 120 are other tube engagement features, such as indentions 186 a,186 b and tube guide 190. The tube guide 190 is adapted to maintain thetube's position in the shuttle pumping region 180.

As illustrated in FIGS. 1C and 1D, the pressure sensors 174 a, 174 bhave corresponding door structures (e.g., protrusions or setscrews) thatensure the tube 160 is sufficiently held against the respective sensor.For example, protrusions 184 a and 184 b correspond to pressure sensors174 a, 174 b. Additionally, protrusion 182 corresponds to ultrasonic airsensor 172. There may also be corresponding door indentions for each ofthe valves 176 a, 176 b. For example, indentions 186 a and 186 b (e.g.,t-shaped indentions illustrated in FIG. 1D) are configured to preventthe tube from dislodging or “snaking” outside of the tube channel. Asillustrated, the indentions 186 a, 186 b in door 120 are sized andshaped to prevent the tube 160 from “walking” out of valves 176 a, 176b.

The door 120 may also include pegs or door latches 192 a and 192 b thatcorrespond to door mounting apertures 194 a and 194 b in the pumphousing. The door latches 192 a, 192 b engage with a slidable latch barmechanism that is operatively connected to the slide clamp mechanismsuch that the slide clamp 115 can be inserted or ejected depending on adoor open or a door closed position. For example, the latch barmechanism may be spring biased towards the downstream side of the pump(e.g., to the left when looking at FIG. 1D) and as the door 120 isclosed, the door latches 192 a, 192 b move the latch bar mechanism tothe right as the door latches 192 a, 192 b are pressed into the pumphousing.

The door 120 may also include a magnet 188 that is associated with aHall effect sensor in the pump 100. The Hall effect sensor is configuredto detect the presence of magnet 188 to determine whether the door 120is closed.

In an example, as a user begins to move the door 120 from an openposition (illustrated in FIGS. 1C and 1D) to a closed position(illustrated in FIGS. 1A and 1B), at least one of the valves 176 a, 176b may occlude the tube 160 during the closing process.

FIG. 2 depicts a high-level component diagram of an infusion pumpsystem. The infusion pump system 200 includes a processor 210 incommunication with memory 212, which is powered by a battery or powersupply 230. The processor 210 communicates with a display 240, a motor250 and associated pumping mechanism 252, and a communication module260. The pump system 200 also may include tube loading guidance modules270, such as a slide clamp indicator 272, tube loading indicators 274,and display instructions 276. Additionally, the infusion pump system 200may include various sensor modules 280, such as a motor encoder 282, anultrasonic air sensor 284, pressure sensors 286, Hall effect sensors288, a slide clamp position sensor 290, optical sensors 292, temperaturesensors 294, an accelerometer 296, and/or an ambient light sensor 298.

The power supply 230 may take many different forms. In one preferredembodiment, the power supply 230 may be in the form of a rechargeablebattery unit. Additionally, the pump may be powered from an AC powersupply. The AC power supply assembly has a power cord and an associatedterminal that plugs into the housing. The AC power supply assembly has aplug that can be inserted into a standard electrical outlet to rechargethe rechargeable battery when necessary. The AC power can also besupplied through the assembly to power the pump.

Sensors Associated with the Pump

The pump sub-assembly, as previously described, has associated therewitha plurality of sensors, which are operative to provide information as tothe function and location of the various elements thereof. A drive motorshaft encoder comprises an encoder flag wheel attached to the armatureshaft of the motor. The pump motor flag wheel may include a plurality offlags (e.g., twelve flags) extending radially outward from the hubthereof.

These flags act in concert with optical switches to fix the location ofthe armature shaft of the pump drive motor. The switches may furtherconsist of a light emitting diode (“LED”) and a photocell. Anarrangement of two optical switches allows for a first switch to sensethe edge of a flag, and the second switch to sense the middle of asubsequent flag. This arrangement allows for greater resolution of motorshaft position and direction as read by the encoder. For example, theresolution of the encoder may be approximately 1/3072 of a rotation ofthe motor shaft.

The motor encoder senses shaft rotation directly. An index wheel mayhave a plurality of circumferentially coextensive radially disposedslots. Associated with these slots is an index wheel optical sensor.This sensor comprises a light emitting diode and an optical sensor orswitch. In an example, the index wheel sensor is cooperative with theindex wheel and the slots therein to provide positional information ofthe rotational location of the pump motor shaft.

In operation, the index wheel sensor acts in concert with the pumpencoder to provide this positional information as well as directionalinformation of the motor shaft. Associated with the shuttle itself is alinear gross position sensor. This sensor comprises a linear positionHall effect sensor and a plurality of magnets. Shuttle position sensormagnets present opposite poles to the shuttle Hall switch, so as toprovide a field gradient operative to provide an indicium of the linearposition of the shuttle.

The combination of the encoder and the other associated sensorsaforementioned, provide inputs to a control mechanism, which may operateto accurately control the speed of the variable speed motor, the primaryfeature provided by such speed control is a temporal variability of theoutput of the pump. Additionally, such speed control allows for anelectronically controlled linearization of the pump output perindividual stroke as well as improving the time-integrated output of thepump.

The infusion pump may also include an ultrasonic air detection apparatusor transducer. The ultrasonic transducer acts in concert with a secondtransducer element to detect air within the IV tubing.

The pump allows the tube to be extended or stretched equally across theface of the associated sensor, thereby eliminating either a volumetricor stress gradient in the tube beneath the associated sensor so as toimprove the accuracy of response of the sensor associated with, orconnected to, housing. Essentially all of the sensors associated with,or actuated by, sensor arm execute the above described motion so as toachieve the above described result.

The pump may also include a downstream pressure sensor and a pluralityof temperature sensors, which consist of thermistors.

The slide clamp may include a Hall effect sensor to identify thepresence and/or position of the slide clamp 115.

Solenoid Actuated Slide Clamp

In an example, a solenoid actuated anti-free flow system mayautomatically eject the slide clamp 115. The automated ejection of theslide clamp 115 may utilize various sensors discussed herein to improvepatient safety (e.g., avoid a free flow condition) and decrease errorsof slide clamp ejection by confirming vital systems in the pump prior toejection. The ejection of the slide clamp 115 may be automated after thesystem establishes that the IV tube is properly installed and loaded,the door is positively closed, and the respective sensors successfullyperform system diagnostic checks.

In an example, a user may manually insert slide clamp 115 and then opendoor 120 of infusion pump 100 and the tube 160 may be positively held inan occluded state. After the door 120 is closed and proper loading isconfirmed, the solenoid actuated anti-free flow system automaticallyejects the slide clamp 115.

Various sensors within the infusion pump may be used for diagnosticchecks. Hall effect sensors in the slide clamp 115 may be used toconfirm that a slide clamp 115 is present. Pressure sensors (e.g.,pressure sensors 174 a, 174 b) may confirm proper IV tube loading.Additionally, a Hall effect sensor (e.g., Hall effect sensor in housing110 and associated magnet 188 in door 120) may confirm that the door 120is closed. Optical sensors, such as optical IR sensors may confirm thatthe door is secured and latched. Additionally, pressure sensors mayconfirm that the door is closed and pressure is maintained. Hall effectsensors positioned within the latch may confirm that valve(s) are close.Any combination of the above sensors may be used for system diagnosticchecks prior to slide clamp ejection. After the established set ofsensors each successfully performs a system diagnostic check, a solenoidis energized and ejects the slide clamp 115.

Slide clamp ejection may also be governed by auxiliary monitoringsystems that confirm other vital information such as patientinformation, medication information, clinician information, and pumpinformation. Auxiliary devices connected to the patient may be used toconfirm acceptability of a drug based on the patient's vital data.

As illustrated in FIGS. 3A, 3B, 3C and 3D, the solenoid 310 ispositioned within the pump housing 110 above the slide clamp channel320. FIGS. 4A, 4B and 4C illustrate several alternative embodiments forauto slide clamp ejection. As illustrated in FIG. 4A, the solenoid 310may also be positioned about the side of the slide clamp channel. Othermechanisms may be used for automated slide clamp ejection such as amotor or rack and pinion. A cam and follower mechanism may also be used.In another example, a shape memory wire 350 with an arrangement ofpulleys 362, 364 and/or 366 may be activated for automated slide clampejection (as illustrated in FIGS. 4B and 4C). For example, the shapememory wire may have a first position (e.g., when the slide clamp isejected) and a second position (e.g., when the slide clamp is loaded).When the slide clamp is ready to be auto ejected, an electrical currentor heat may be applied to the wire so that the wire changes from thesecond position to the first position and automatically ejects the slideclamp 115.

FIG. 5 illustrates an example IV set loading sequence 500 a. Forexample, when IV tube loading starts (block 502), the Hall effect sensorin the slide clamp 115 detects that the slide clamp 115 is present(block 504). Then, the door 120 is opened and the IV tube 160 is loaded,which is confirmed by a pressure sensor (e.g., pressure sensors 174 a,174 b) (block 506). Once the door 120 is closed, another Hall effectsensor (e.g., sensor associated with magnet 188) confirms that the door120 is in the closed position (block 508) and an optical IR sensorconfirms that the door link is latched (block 510). Then a Hall effectsensor confirms that at least one valve (e.g., valves 176 a, 176 b) isclosed such that the IV tube 160 is closed (block 512). For each ofblocks 504 to 512, the pump may provide tube loading guidance (LED,display, audio, etc.) as further described below (block 514). After eachof the above sensors confirms that IV tube 160, door 120, and valve(e.g., valves 176 a, 176 b) are loaded and/or positioned, the pump 100provides power to energize the solenoid (block 516). Then, the solenoidis activated to automatically eject the slide clamp 115 (block 518).Once the slide clamp 115 is ejected, the pump 100 may initiate aninfusion (block 520).

FIG. 6 illustrates an alternative IV set loading sequence 500 b. Forexample, after the above sensors confirm loading and positioning of thepump components (e.g., blocks 502 to 512), the pump may also confirmpatient, medication, clinician (e.g., doctor or nurse), and/or pumpinformation (block 552). Patient's vital signs may also be confirmedthrough patient monitoring systems (block 554). Then, the solenoid maybe energized and ejected (blocks 516 and 518) based on these additionalsafety checks and constraints.

Unlike systems that use mechanically timed slide clamp releases, thepresent disclosure provides additional patient safety that takesadvantage of system diagnostic checks using a multitude of sensors toensure proper tube loading and pump configuration.

Occlusion Detection

Occlusions may be detected by monitoring force and/or pressuremeasurements using various techniques. Additionally, the user may selectbetween rapid occlusion detection and non-rapid occlusion detection. Inrapid occlusion detection mode, the syringe pump 100 may report anocclusion at 50% of the force or pressure thresholds discussed below.

Difference Value from Baseline

A baseline force value (e.g., a moving or sliding average window offorce measurement samples, such as twenty samples) may be taken afterthe motor starts. The force and/or pressure sensor may output an Analogto Digital Converter (“ADC”) count. In an example, the baseline forcevalue may be a window of 20 samples of ADC counts after the pump motorstarts. The current force measurement may be monitored and a differencevalue (e.g., baseline force value subtracted from the current value) maybe determined. If the difference value exceeds a predeterminedthreshold, an occlusion alarm may sound. The pump may have varioussettings for various occlusion detection sensitivities (e.g., Very High,High, Medium High, Medium, Low, and Very Low).

In an example, the syringe pump 100 may generate a high prioritydownstream occlusion alarm for the following fluid pressures andsensitivities: (Sensitivity—Very High; Occlusion pressure 50 psi; LowerLimit 25 psi; Upper Limit 52 psi); (Sensitivity—High; Occlusion pressure16 psi; Lower Limit 13 psi; Upper Limit 18 psi); (Sensitivity—MediumHigh; Occlusion pressure 13 psi; Lower Limit 10 psi; Upper Limit 15psi); (Sensitivity—Medium; Occlusion pressure 10 psi; Lower Limit 7 psi;Upper Limit 12 psi); (Sensitivity—Low; Occlusion pressure 7 psi; LowerLimit 4 psi; Upper Limit 9 psi); and (Sensitivity—Very Low; Occlusionpressure 4 psi; Lower Limit 1 psi; Upper Limit 6 psi).

In another example, the syringe pump 100 may generate a high prioritydownstream occlusion alarm for the following fluid pressures andsensitivities: (Sensitivity—Very High; Occlusion pressure 50 psi; Limit<52 psi); (Sensitivity—High; Occlusion pressure 16 psi; Lower Limit 12psi; Upper Limit 20 psi); (Sensitivity—Medium High; Occlusion pressure13 psi; Lower Limit 10 psi; Upper Limit 15 psi); (Sensitivity—Medium;Occlusion pressure 10 psi; Lower Limit 7 psi; Upper Limit 12 psi);(Sensitivity—Low; Occlusion pressure 7 psi; Lower Limit 4 psi; UpperLimit 9 psi); and (Sensitivity—Very Low; Occlusion pressure 4 psi; LowerLimit 2 psi; Upper Limit 8 psi).

For an infusion pump, the tubing relaxes into the channel causing achange in force, which is dependent on temperature. For example, thetube material properties change based on temperature and a temperaturecompensation slope may be added for both the baseline force value aswell as current ADC values. However, for a syringe pump, the syringeforce contact is non-relaxing in nature and a change in temperature doesnot cause a material property change. Also, the force sensor for thesyringe pump is rated and compensated to operate from −10 degrees to 40degrees C., which covers typical pump operating ranges without affectingsystem level temperature variations in down stream occlusion (“DSO”)detection for the syringe.

After the pump reaches steady state, occlusion detection may be based ona change in pressure or delta pressure instead of the High, Medium, orLow threshold settings. For example, after reaching steady state wherethe pressure is very steady, a sudden shift upwards for pressure mayindicate that the pump is trending to occlusion. Monitoring a deltapressure after steady stay may allow for earlier occlusion detection.

In an example, steady state is achieved when there is less than a one(1) psi pressure change in the last two minutes of pressuremeasurements. If the system is not in a steady state condition, pressuredelta sensing may be disabled.

The pump may also monitor changes in pressure as a function of flowrate. Different baseline and/or different threshold levels may beestablished based on the flow rate. For example, if the difference inpressure from baseline exceeds a predetermined relationship (e.g.,pressure Increase=0.3*Flowrate in a 1 minute duration), an alert orwarning for an occlusion sounds.

Slope of Pressure Measurements

An occlusion alarm may be generated if the slope calculated from thedifference of two pressure measurements exceeds a threshold value. Thepressure measurements may be taken in a predetermined window or timeinterval, for example, every two seconds. In an example, two differentslope measurements may be used to account for any braking forces at thestart of an infusion. To prevent false alarms, the initial thresholdvalue may be higher to account for braking forces from the tubing orother pump components at start-up. After start-up, the threshold valuemay be lower after the pump has overcome the braking forces.

Area Under Force Curve

Occlusion detection may also be based on energy spent or the areabetween a base line and the current force line. The area calculation maybe compared to a threshold value.

Downstream Tube Pull Detection

False alarms are an increasing issue in the infusion world. Patientmovement may result in pulls or tugs of downstream tubing. This patientmovement often leads to line management issues and it becomesincreasingly challenging to differentiate between a false alarm from atrue occlusion.

A pressure may be monitored where the pressure is equal to the currentADC minus baseline ADC multiplied by a factor of (1/DistCalSlope) (e.g.,Pressure=(Current ADC−Baseline ADC)*1/DistCalSlope). The current ADC maybe a window or continuous moving average of 50 samples of ADC countstaken during the pumping phase at 200 Hz. The baseline ADC may be arolling sum of 50 samples of the first 50 ADC counts after the pumpstarts. The “DistCalSlope” term is a two-point slope (points taken at 2psi and 15 psi) during manufacturing calibration. For example, the“DistCalSlope” term is equal to the difference of the ADC taken at 15psi and 2 psi divided by the difference of the psi values (e.g.,DistCalSlope=(ADC at 15 psi−ADC at 2 psi)/(15−2).

After the baseline ADC is determined, the baseline is held constantwhile the current ADCs are typically higher than the baseline ADCs. Ifthe current ADCs are lower than the Baseline ADCs, then the baseline ADCmay be updated to the current ADC. For example, the current ADC may belower than baseline ADC due to tube relaxation and updating the baselineADC to the current ADC accounts for the tube relaxation.

If the pressure calculated is greater than an established threshold, anocclusion is detected. Additionally, if an occlusion is detected, thepump may be stopped and a high priority occlusion alarm is communicatedto the clinician.

As discussed above, the pump may have various settings for variousocclusion detection sensitivities (e.g., Very High, High, Medium High,Medium, Low, and Very Low). Additionally, the lower limit may be updatedto help distinguish tube-tugging and sudden drop scenarios from tuberelaxation. In an example, if a tube pull or tug is detected, an alertor communication may be conveyed to the user to stop pulling on thetubing

Accelerometer

Digital moving average filters filter out unwanted spikes and/or noisesignals. However, mechanically generated noise may also be unexpectedand irregular which may lead to false alarms. In some instances, themechanically generated noise may be more problematic than electricalnoise.

An accelerometer may be used to help distinguish and/or filtermechanically induced sudden noises and/or spikes. Example sources ofsuch noise may be from an operator pushing on the door of the infusionpump, an operator bumping into the pump, an operator moving the pump andpatient while infusing, etc.

If the pump 100 drops from a height or an impact causes the pump tosyphon or bolus, a separate high priority alarm can be sent to the user.If the accelerometer picks up mechanical movement/vibrations due to doormovement or key selection (e.g., pressing display or physical keys), afeedback signal is sent to pump to not alarm or auto-restart because theevent was purely caused by a sudden mechanically induced spike.Consequently, following an impact/drop a separate diagnostic algorithmis run on the sensors to test the functionality of the sensors and/orother critical components. For example, the diagnostic algorithm mayensure that the impact or drop did not disable or impair any of thesensor functions to ensure that the pump can detect and filter futurevibration or drop events. When there is no impact but sudden irregularpressure spike(s) are detected by the occlusion algorithm, it can beconfirmed from the accelerometer that it was purely electricallyinduced. If these spikes are sudden and irregular and not within anexpected occlusion spike range an electrically induced sensor failurealarm is generated.

With an accelerometer sensitive enough to detect smallermovements/vibrations, a tubing tug or pulled scenario is confirmed inaddition to the force sensor signal characteristics.

As illustrated in FIG. 7 , a moving average force sensor may monitor theforces applied to select locations on the pump (block 562). If adisturbance, or sudden pressure/force spike is detected (block 564), thesystem may check whether the accelerometer has detected an externallyinduced sudden or irregular disturbance (block 566). If theaccelerometer has detected an externally induced and irregulardisturbance, the pump may disregard the force sensor disturbance (block568) and continue monitoring (block 562). However, if the accelerometerhas not detected an external event, the pump may generate a failurealarm signal to indicate an alarm condition, such as the presence of anocclusion (block 570).

Tube Loading Guidance

Sensors within the infusion pump may also be used for tube loadingguidance. The IV set or tube loading guidance advantageously providesclinical staff with visual confirmation of proper IV set or tube loadingto ensure patient safety during infusion preparation. In an exampleembodiment, the display and visual cues may be positioned on the pump toprovide visual guidance to user's during IV tube loading. The pump maybe configured to detect a user's presence in the pump's proximity. Forexample, a Long Wavelength Infrared (“LWIR”) system may detect a user'spresence in the pump's proximity. In another example, an ambient lightsensor may be used to detect a user's presence. As a user approaches thepump, the pump detects the user's presence and if there is no IV tubeloaded, a visual cue is provided to indicate where to insert the slideclamp. For example, an illuminated ring or other shape may indicatewhere to insert the slide clamp. Simple point LEDs may also indicatewhere to insert the slide clamp.

Initially, the pump may be powered on without an IV tube loaded. At thisstage, a light indicator for slide clamp loading may be pulsing orblinking. The rate of pulsing or blinking may depend on whether the pumpis running off battery power or is plugged-in and is using a power cord.The display may be used to support a user with further visual guidanceprior to the door opening. Then, the user may insert the slide clamp.After inserting the slide clamp, the slide clamp light changes colorwhile the door opens and the light indicator around the perimeter of theslide clamp is now in an “ON” state indicating the next step to theuser. As the user loads the IV tube throughout the IV tube channel,various critical loading points may include other visual and audioguidance to complete the IV tube loading sequence.

As illustrated in FIG. 8A, a rectangular shape 610 a (e.g., slide clamparea) is illuminated, for example in a yellow color (e.g., yellowpulsing light), to indicate where the slide clamp 615 should be inserted(e.g., slide clamp slot 620). The color of illumination may alsoindicate that the slide clamp 615 has not yet been inserted (e.g., afterinsertion the yellow illumination may change to a green illumination).The display 630 may provide additional guidance to the user throughinstructions or prompts. For example, as illustrated in FIG. 8A, thedisplay 630 may provide a message to the user, such as “To load the IVtube set, Insert slide clamp into opening.”

After the user successfully loads the slide clamp 615, the illuminatedshape 610 (e.g., rectangle around the slide clamp area) may change froma yellow color (as illustrated in 8A as rectangular shape 610 a) to agreen color (as illustrated in FIG. 8B as rectangular shape 610 b) toindicate that the slide clamp 615 has been loaded. For example, thechange from yellow to green may serve as a confirmation that this stagein the tube loading sequence has been properly completed. At this point,the user may open the door 640 and additional visual cues such as (e.g.,LED lights 650 and 660) positioned behind the door, may guide the userfor loading the tube. Once the door is opened, the display 630 is nolonger visible to the user, and colored LEDs 650, 660 are used toconfirm various load points. In FIG. 8B, there are two different loadpoints 670 a, 670 b that are indicated with LEDs 650, 660. AdditionallyLEDs or other visual cues may indicate other load points along the tubepath.

The LEDs 650, 660 may originally display a first color (e.g., red ororange) if the tube has not been loaded or has been improperly loaded.The LEDs 650, 660 may then display a second color (e.g., green) once thetube has been properly loaded. In another example, the LEDs may pulse orblink to indicate whether a tube has been loaded. For example, ablinking LED may indicate that a tube is improperly loaded or unloadedand a solid colored LED may indicate that the tube is properly loaded ata respective load point. Initially, an indicator such as LED 650 a maybe pulsing orange to provide visual guidance and advise the user of thenext tube-loading step. After the user loads the tube at a respectiveload point (e.g., load point 670 a), the indicator (e.g., LED 650 a)associated with that load point 670 a may change from pulsing orange toa solid or steady green color. Then, the next indicator (e.g., LED 650b) associated with load point 670 b may start pulsing to indicate thenext loading step to the user.

Colors as well as animations may be used to indicate pump states and IVset or tube loading confirmations. For example, animations as well aspulsing, flashing or blinking lights may indicate the pump and IV tubeloading states. It should be appreciated that any type of visualindicator or cue may be used and that LEDs are provided by way ofexample.

The pump may also use audible cues or tactile cues to inform or alertthe user during tube loading. For example, the pump may use anassortment of beeps or vibrations to indicate the various stages of tubeloading.

FIGS. 9A, 9B, and 9C illustrate example visual indicators during tubeloading. In FIG. 9A, the slide clamp indicator area (e.g., rectangularshape 610 b) is illuminated green after the slide clamp 615 has beensuccessfully loaded. As the tube is loaded into each successive loadpoint (e.g., load points 670 a and 670 b), the LED indicators 650 and660 changes from red to green as illustrated in FIGS. 9B and 9C. The LEDindicators may also change from yellow to green or any other colorcombination. As shown, the LEDs 650, 660 change from the first color tothe second color once proper tube loading is detected and confirmed.Other visual indicators other than color may be used. Additionally, theindicators 650, 660 may have various geometries and shapes (e.g.,circle, ring, triangle, square, etc.).

As illustrated in FIG. 9B, the tube is properly loaded in load point 670a and the LED indicator 650 changes from a first color (illustrated as650 a) to a second color (illustrated as 650 b) to provide a visual cueto the user that the tube has been properly loaded. As discussed above,other cues may be provided to the user such as an audible beep. At thispoint in FIG. 9B, the tube has not yet been loaded into load point 670b, so LED indicator 660 is still in the first color (illustrated as 660a) to indicate that the tube has not been properly loaded at that loadpoint.

As illustrated in FIG. 9C, the tube is properly loaded in load point 670b and the LED indicator 660 changes from a first color (illustrated as660 a) to a second color (illustrated as 660 b) to provide a visual cueto the user that the tube has been properly loaded at that respectiveload point. After the tube has been properly loaded and the door isclosed, the pump may be ready to program an infusion. Then, the slideclamp indicator area (e.g., rectangular shape 610 b) may be activated ina different color to indicate to the user to eject the slide clamp andstart the infusion.

As discussed herein, ejection of the slide clamp may occur automaticallyafter confirmation from various sensors. However, in embodiments withoutautomated ejection, after the user closes the door, a visual cue such asan illuminated area may indicate the location of the slide clampejection button. In another example, the button may be a backlight suchthat the entire slide clamp ejection button lights up for the user.Additionally, the display may prompt the user with a message, such as“Press button to eject slide clamp.” Upon infusion completion, the slideclamp area may again be indicated by a light so that the door can againbe opened by inserting the slide clamp.

In addition to color indication for slide clamp and tube loadingguidance, LEDs may be cycled to indicate various stages of IV tubeloading. For example, if a load has not yet been attempted, the LED mayslowly pulse. If a load is completed successfully, the LEDs may bepermanently on. Various LED colors may also be used to furtherdistinguish the tube loading stages. Yellow may be used in a slow pulseor where the LED is slowly “breathing” to indicate that a load has notyet been attempted. Green may be used when the load is completedsuccessfully, and the LEDs may be colored red when flashing to indicatethat the load was not successful or that the IV popped out of a loadpoint.

The guidance described herein advantageously improves patient safety byenhancing IV tube loading (e.g., insertion) guidance with confirmationof each completed loading step via visual and acoustic guidance. Forexample, tri-color or discrete color LEDS, light-guides, diffusers,light-guides with integrated diffusers, display screens, speakers andother acoustic elements (or a combination thereof) may be positioned onthe pump and activated in specific combinations or sequences to provideguidance to the user while loading an IV tube.

Other Pump Guidance/Operational Indicators

The LEDs (e.g., 610, 650, 660 of FIGS. 8A to 9C or 910, 950 a-c of FIG.10 ) may also be used to indicate the pump is “ON” as well as flowdirection. In some examples (e.g., with multi-colored LEDs such astri-colored LEDs) the LEDs may be used to indicate some of the basicpump states when the display is off to reduce power consumption asillustrated in FIG. 10 . As illustrated in FIG. 10 , the load point LEDs(e.g., 950 a-c) may be integrated on the external edge of the pump forimproved visibility. Additionally, the LEDs 950 a-c may be used toindicate pump status in a low power state consumption level.

The visual cues and/or other indicators such as audible cues and tactilecues may work in conjunction with the display to provide guidance andinformation to a user.

Operation of each of the above modes may be changed within the pumpsettings. Additionally, the display may depend on whether operation isfrom the power cord or battery. For example, to conserve the battery,the LED (e.g., 610, 650, 660 of FIGS. 8A to 9C or 910, 950 a-c of FIG.10 ) and other light indicators may be used. However, when operating viaa power cord, both the LED/light indicators and the display may be usedto provide visual indications and prompts to the user.

Rack Power Management

The infusion pump disclosed herein and/or a syringe pump may be usedwith a rack configured to house one or more pumps (e.g., infusion and/orsyringe pumps). The rack may provide dynamic power and heat managementfor each pump housing within the rack. The power and heat management maybe based on medication criticality that each respective pump isdelivering. For example, a pump housed in the rack that is delivering ahighly critical medication may be allocated more power so that thebattery is charged to a level that reduces risk to the patient from adepleted battery after AC has been removed.

The rack may assist with pump identification, pump-to-pumpcommunication, pump-to-rack and rack-to-pump communication, pump batterycharging, etc. The rack may also manage power based on medicationcriticality and may also manage motor consumption per medication needs.

The rack may provide a common display and external connectivity via awired or wireless connection.

The rack may implement several methods or procedures to control batteryconsumption and charging of the various infusion pumps and/or syringepumps housed in the rack. The rack may allow a pump power supply or wallwart to draw higher current for faster charging. For example, the rackmay allocate rack power to each pump such that its battery will becharged to a level that reduces risk to a patient from a depletedbattery after AC-power has been removed. If a patient is receiving acritical medication along with a noncritical IV solution, the pumpdelivering the critical therapy may be given charging priority such thatit is allowed to charge its battery faster than other pumps housed inthe rack. The rack may also manage the amount of power that a pump isusing for things other than battery charging, such as driving its motor.If one pump is using more power to drive its motor then that pump may beallowed to have a higher charge current so that when unplugged, the runtime on the battery will be similar for all pumps housed in the rack.The rack may also prioritize and assign fast charging vs. tricklecharging on a pump-to-pump basis based on criteria, such as charge need,medication being delivered, etc.

The rack may also detect failure modes, such as exceeding thermalconstraints on power supplies.

The many features and advantages of the present disclosure are apparentfrom the written description, and thus, the appended claims are intendedto cover all such features and advantages of the disclosure. Further,since numerous modifications and changes will readily occur to thoseskilled in the art, the present disclosure is not limited to the exactconstruction and operation as illustrated and described. Therefore, thedescribed embodiments should be taken as illustrative and notrestrictive, and the disclosure should not be limited to the detailsgiven herein but should be defined by the following claims and theirfull scope of equivalents, whether foreseeable or unforeseeable now orin the future.

1. A tube pull detection system for an infusion pump comprising: ahousing with a door pivotally mounted to the housing; a tube channelpositioned at least partially behind the door on the housing, the tubechannel configured to hold a tube in the infusion pump; and a tube pulldetection device configured to detect tube pull based on one or moreinputs from one or more sensors configured to detect the presence of thetube at a load point along the tube channel or one or more additionalsensors arranged on the infusion pump.
 2. The tube pull detection systemof claim 1, wherein the one or more additional sensors include at leastone occlusion sensor configured to detect tube pull by detecting strainon the tube.
 3. The tube pull detection system of claim 1, wherein thetube pull detection device is configured to detect tube pull based ondetecting a change of pressure in the tube.
 4. The tube pull detectionsystem of claim 1, wherein the one or more additional sensors include atleast an accelerometer.
 5. The tube pull detection system of claim 1,wherein the tube pull detection device further comprises a plurality oftube pull detection sensitivities, wherein each sensitivity comprises arange of limits of detected tube pull.
 6. The tube pull detection systemof claim 5, further comprising a user feedback system, wherein the userfeedback system includes one or more visual or auditory cues configuredto provide guidance to a user.
 7. The tube pull detection system ofclaim 6, wherein the visual cues include a first light-emitting diode, asecond light emitting diode, and a display and the auditory cues includea first alarm and a second alarm.
 8. The tube pull detection system ofclaim 7, wherein, in response to the tube pull detection devicedetecting tube pull within a specified sensitivity, at least one of thefirst light-emitting diode, the second light emitting diode, thedisplay, the first alarm and the second alarm provides guidance to theuser connected to the infusion pump.
 9. The tube pull detection systemof claim 8, wherein the first and second alarms are configured toindicate whether the tube pull detection device detects tube pull withina first tube pull sensitivity or a second tube pull sensitivity.
 10. Thetube pull detection system of claim 1, wherein the one or moreadditional sensors include at least one of a first Hall effect sensorconfigured to detect when the door is positioned in a closed state, anoptical IR sensor configured to detect when the door is latched whilepositioned in the closed state, and a second Hall effect sensorconfigured to detect that a valve is closed to place the tube in anoccluded state.
 11. A method of detecting tube pull downstream of aninfusion pump, the method comprising: monitoring a pressure measurementof a tube of the infusion pump connected to a patient, wherein thepressure measurement is based on a current ADC measurement, a baselineADC measurement, and a slope of an ADC-pressure plot; comparing thepressure measurement to a threshold based on a selected tube pullsensitivity; and determining tube pull exists on the tube of theinfusion pump when the pressure measurement is greater than thethreshold.
 12. The method of detecting tube pull of claim 11, furtherincluding providing feedback to a user via a user feedback system,wherein the user feedback system includes one or more visual or auditorycues.
 13. The method of detecting tube pull of claim 12, whereinproviding feedback via the visual cues includes illuminating a firstlight-emitting diode, illuminating a second light emitting diode, andilluminating or displaying a message on a display and wherein theauditory cues includes a providing a first alarm and providing a secondalarm.
 14. The method of detecting tube pull of claim 13, wherein, inresponse to the tube pull detection device detecting tube pull existswithin a specified sensitivity, illuminating at least one of the firstlight-emitting diode, the second light emitting diode, the display, orplaying the first alarm and the second alarm to provide guidance to auser.
 15. The method of detecting tube pull of claim 13, includingindicating via the first and second light emitting diodes whether thetube is properly or improperly loaded at respective load points on theinfusion pump.
 16. The method of detecting tube pull of claim 13,including indicating via the first and second alarms whether the tubepull detection device detects tube pull within a first tube pullsensitivity or a second tube pull sensitivity.
 17. The method ofdetecting tube pull of claim 11, further comprising monitoring, via anaccelerometer, the motion of the tube and comparing the motionmeasurement to a threshold based on a selected tube pull sensitivity.18. The method of detecting tube pull of claim 12, wherein the selectedtube pull sensitivity includes one of a rapid detection sensitivity anda non-rapid detection sensitivity, and wherein the threshold is lowerfor the rapid detection sensitivity than the non-rapid detectionsensitivity.
 19. The method of detecting tube pull of claim 12, furthercomprising in response to determining tube pull exists on the tube,transmitting a signal to the infusion pump, the signal configured tocause the infusion pump to pause or stop operation.
 20. An infusion pumptube pull detection device comprising: one or more sensors configured todetect the presence of a tube at a load point along a tube channel orone or more additional sensors arranged on the infusion pump, whereinthe infusion pump tube pull detection device is configured to detecttube pull based on one or more inputs from the one or more sensors; anda user feedback system, wherein the user feedback system includes one ormore visual or auditory cues configured to provide guidance to a userspecific to a plurality of tube pull detection sensitivities, whereineach sensitivity comprises a range of limits of detected tube pull basedon the one or more inputs from the one or more sensors.